Provider Demographics
NPI:1285220160
Name:HOEFLE, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HOEFLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:VAN HORNE
Mailing Address - State:IA
Mailing Address - Zip Code:52346-0236
Mailing Address - Country:US
Mailing Address - Phone:319-228-8100
Mailing Address - Fax:
Practice Address - Street 1:122 MAIN ST
Practice Address - Street 2:
Practice Address - City:VAN HORNE
Practice Address - State:IA
Practice Address - Zip Code:52346-9718
Practice Address - Country:US
Practice Address - Phone:319-228-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19299183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist